In simple terms, a Scrinch is a strain, sprain, stress or any equivalent term used to refer to any injury to soft tissue as a result or consequence of sudden/inappropriate movement. Injuries from impacts are not included in this category. How you handle a scrinch, especially on the first day will determine the speed of recovery.
Some days back, while bending forward to tie my shoelace, I scrinched my lower back in one sudden, unexpected instant. One moment I was la-de-dah about the great outdoors and the next, absolutely still, with nothing but my back in the front of my mind.
When I think of it now, I feel it was waiting to happen for quite a while. I had not been exercising of late and ye olde muscles had been steadily fattening up on the rich food and lazy lifestyle. I could sense an increasing degree of lethargy and insincerity in them, even with moderate workloads. It was cause for concern, for these things could be early signs of mutiny, but the Central Vigilance Unit from the Grey Matters Dept of the Upper Chamber were in a holiday mood and neglected the warnings.
So, when I crossed one leg across the other and leaned forward to tie the shoelace, I inadvertently isolated a particularly lazy group of myocytes by this action and yanked them out of their bed. There was immediate protest. I heard something go 'snap'. It was a squelchy, stringy, muted kind of snap that arises out of soft tissue being torn apart by alien critters feeding on human flesh in some B grade horror-sci-fic production. The myocytes started creating a ruckus, yelling and screaming and causing intense local pain in the process. Others quickly joined in and took up the cause, as willingly as the Bengali Babu, who, while hurrying to office, spots a small gathering of three people protesting against the government for building the airport near their home and offers to shout their slogans for them while they put up their posters on the nearby wall. The commotion spread slowly, but surely, outwards like a mutinous tide and pretty soon, all routes to and from the place started jamming up. The Tubes (Arteries) started constricting and impeding adequate passage of the myriad traffic. The angry mob took to the streets through their individual by-lanes, further clogging them up. As the by-lanes opened, plasma, that soupy medium through which all the cells move, started leaking out and congealing the neighborhood in a slow-motion tsunami. It caught those myocytes in the area, who were hitherto unaware of the disruptions around them, in the middle of their routine activities and threw their peace of mind out of gear. Naturally, they ganged up and grabbed their banners on the way out. Pretty soon the district authorities were in a frenzy and put on the sirens and switched on the heaters (whenever there is disruption in peace and tranquility, law and order, heaters are switched on to disperse the unruly crowd. These heaters glow red). Everything comes to a standstill till law and order returns.
Movement was painful, to say the least. This was no ordinary pain to trifle with. It was sharp and piercing when I bent forward, stretching and tearing when leaned backward and a complaining ache on either side. Twisting was like someone pulling a cistern chain dangling from the brain. As I sat perfectly still, wondering what to do, I recalled a dozen examples of people lying in bed as a consequence of sudden back scrinches, none of them particularly heartening.
These are the typical signs of an inflammation. Whenever, wherever there is damage to tissue in any form, the reaction of the tissue up to the time of complete healing is controlled by this process. There are five elements of an inflammation: Rubor - Redness, Calor - Increase on temperature, Dolor - Pain, Tumour - Swelling and Functio laesa - Loss of function. The Romans couldn't find one word for it, so we also couldn't. Redness is caused by an excess flow of blood to the area. This happens only in the initial stage, when the rowdies are still within their work area. It's the police rushing in. Blood brings in a rise in temperature and a host of defensive chemicals are secreted by the cop-cells or corpuscles. All these activities activate the nerve pathways and they start sending pain messages to the Dept of Pain in the Brain. The Dept of Pain issues orders on nature and severity of the pain (that The Body will perceive and suffer from) only after referring the matter to the Dept of Tolerance, which has a significant say on the final degree of pain before it is dispatched to the Dept of Perception, which may or may not send a Directive to the Dept of Sound to produce a noise, as appropriate to the Recommendation of the Dept of Tolerance mentioned before. With a lot of plasma pouring out of the leakages in the Transit Tubes or arteries, the healthy tissue areas are permeated and the entire area swells up and becomes tender to touch or pressure, as also any movement. The common refrain is - "Let status quo prevail." As a result, there is loss of function - same as when factory workers go on strike.
The obvious thing to do was to assess the extent of damage, so I froze until the pain subsided. Slowly, I assisted the already hoisted lower limb to it's appropriate position on terra firma and despatched two sets of fingers to examine and report back on the back. The report would read something like this: alignment of bones (vertebrae)- normal, protrusions/ gaps - nil, tenderness - moderate, localised but not distinctly at one place, nature of pain - as arising out of superficial soft tissue, movement - painful but bearable if gradual. By saying 'gradual', I mean the average speed of an aging snail. Inference- localised muscle tear/pull but spinal alignment - OK. In other words, a Grade II Scrinch of the lower back at the level L5-S1. Further experiments on studying the characteristics of the pain while cautiously shifting positions confirmed the exact site and nature of damage.
Low back aches of sudden onset are the commonest of scrinches followed by those of the upper back, (tennis) elbow, knee and shoulder joint. Most are caused by sudden, dis-coordinated movement resulting in over-stretching of muscle fibres (upper back, calf) or ligaments (knees, ankles) or sometimes, both (lower back). A few are caused by lack of movement; over-stretching tissue over a prolonged period of time - like a hand used overnight as a pillow produces a swollen, tender elbow for a couple of days.
I got up and walked around a few experimental steps. It was not as bad as I had dreaded. My father had had a bad back and was prone to such painful episodes, which he would pragmatically term as 'inconveniences' and lie down still, sometimes for days, until it healed. But, that was an unexpected proposition as I had serious business to attend to before going for my daily toil to earn bread and butter (he was a govt employee with leave privileges while I am a paid-by-the-hour guy). So, I just went ahead and did what I was supposed to do, which started with an hour of loitering around on uneven land in the sun, supervising a boundary wall construction and then sitting for five-and-a-half hours (with a half-hour break in between) attending to patients who had no idea that they were with a very patient patient, who was grinning and bearing it. The entire lower back bunched up into one amalgamated, indistinct, stiff mass of pain. Walking around helped. The tablet I had taken after lunch was somewhere inside me, doing nothing. Getting in and out of my car was an exercise of contortions (of body and face) in slow-motion.
Back at home, I was subjected to standard procedures. I was asked to lie still on my tummy while a vile smelling gel was liberally applied and massaged in. The heating pad was next and I was subjected to a slow roasting while contemplating the vagaries that make up the complicated process of living. Pretty soon the old spirit of rebellion made its presence felt and I was back on my feet. After that, it was normalcy with the exception that no position sitting or standing, erect or slouching was comfortable for very long and all my effort went in trying to maintain a neutral position for the affected group of muscles.
Inflammatory signs typically peak in 72 hours and then subside. In my case, it started abating in 48 hours. Three things must have attributed to this early recovery- keeping the injured muscles relaxed as far as possible, no prolonged immobility and further heating. All the poor chaps wanted was a few days sick leave and I was willing to grant them that.
It would come at the cost of overworking a few others, but they were a well-fed, healthy lot and needed the occasional exercise. The heating seemed to be a bad idea. When you target an area that is several layers of cell down, you have to raise the surface temperature to a much higher degree to achieve any satisfactory diffusion of heat to the desired level. In that process, you manage to overheat healthy cells and create more morbidity. It's has the same effect on people standing close to huge speakers when you decide to entertain a group of people 50 meters away. There was also a problem with lying down for long. Barring the fact that people have by and large forfeited the luxury of a few days rest, by way of their complicated existential liabilities, no single position can ensure equal rest to adjacent groups of injured as well as healthy muscle tissue. That may be accepted as a fact.
So, here's a brief summary on dos and don'ts in handling scrinches.
Prevention:
1. Limber up in the mornings. Avoid deliberate bending or stretching without a cardio workout first. RBCs are the supply trucks that get oxygen to the tissues. Get them moving. Everybody cheats unless you supervise their activities.
2. The time period from and up to an hour after your bath is a vulnerable period for muscles. They are about as disciplined as a bunch of kids in a swimming pool. Take care to avoid sudden and stretching movements.
3. After exercise, cool down as naturally as possible. Losing heat quickly stiffens muscles and slows them down. If you are resting between activities, do not allow complacency to set in, something I realised during my Himalayan trek. (The locals rarely sit down to rest).
4. Electrolyte replenishment helps when you sweat a lot. But, everyone knows that these days and many end up in osmotic diarrhoea after overdoing this.
Management:
1. On occurence, keep still until you have yourself assessed the extent of damage and are sure of your moves. If asking for help, explain what you want to be done without ambiguity.
2. Any injury involving bones and joints are not to be self-managed.
3. Local application of gels and liniments helps as long as it is not rubbed in with pathological vigour.
4. Heat application must be limited to a peak surface temperature not exceeding 45*C. After that the superficial cells start suffering from heat fatigue and lose efficiency.
5. For the next three days the three foremost considerations should be comfortable posture, painless posture and a change of posture if the first two are not achieved.
6. Laga helps.
Note: There is no term as 'scrinch', but a scrinch by any other name is still a scrinch.
